Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2025 Provider Newsletter) [Read]

Attention Behavioral Health Providers: Monthly Behavioral Health Training Assistance (BHTA) Webinar Scheduled [See Web Announcement 2009]

Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims [Announcement 850]

If you are a Medicaid provider whose revalidation application has not been processed by your termination due date, you will be ineligible to provide services to any Nevada Medicaid or Nevada Check Up recipients, including both Fee-for-Service and Managed Care Organization (MCO) enrolled recipients. See Web Announcement 1265

Enrollment Termination Frequently Asked Questions (FAQs) [Review]

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Notifications

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

Attention Providers Using the Authorization Criteria Function: Results that return prior authorization (PA) requirements are accurate. For results that return “There are no records found based on the search criteria,” there may be a PA requirement if limits have been exceeded. To verify PA requirements, please refer to the Medicaid Services Manual (MSM) Chapter for your service type at dhcfp.nv.gov and the Billing Guide for your provider type at www.medicaid.nv.gov.

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Scheduled Site Maintenance

During the scheduled site maintenance window the Provider Web Portal will be unavailable. The table below shows the regularly scheduled maintenance window. All times will be in the Pacific time zone.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

Substance Use Treatment (SUT)

Specialty Description Updated Date
701 Certified Alcohol and Drug Counselor (CADC) 11/19/24
702 Licensed Alcohol and Drug Counselor (LADC) 11/19/24
703 Certified Alcohol and Drug Counselor Intern (CADC-I) 11/19/24
704 Residential Substance Use Treatment in an Institution for Mental Disease (IMD) 03/25/25
705 Licensed Clinical Alcohol and Drug Counselor Intern (LCADC-I) 11/19/24
706 Peer Recovery Support Specialist (PRSS) 11/19/24
707 Substance Use Treatment Clinic 03/25/25
708 Opioid Treatment Program 03/25/25
709 Licensed Clinical Alcohol and Drug Counselor (LCADC) 11/19/24

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If you have any questions, please contact the Provider Enrollment Unit at (877) 638-3472 from 8:00AM to 5:00PM, Monday through Friday.